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Antibiotics for early-onset neonatal infection: Antibiotics for the prevention and treatment of early-onset neonatal infection [CG149]

Measuring the use of this guidance

Recommendation: 1.3.1.5

Offer benzylpenicillin as the first choice for intrapartum antibiotic prophylaxis. If the woman is allergic to penicillin, offer clindamycin unless individual group B streptococcus sensitivity results or local microbiological surveillance data indicate a different antibiotic.

What was measured: Proportion of protocols that stated benzylpenicillin was the firstline medicine used for intrapartum antibiotic prophylaxis.
Data collection end: June 2014
95.1%
Number that met the criteria: 117 / 123
Area covered: UK
Source: Royal College of Obstetricians & gynaecologists. Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK.


Recommendation: 1.5.1.3

Perform a lumbar puncture to obtain a cerebrospinal fluid sample before starting antibiotics if it is thought safe to do so and: • there is a strong clinical suspicion of infection, or • there are clinical symptoms or signs suggesting meningitis.

What was measured: Percent of babies who required intravenous antibiotics for suspected or confirmed early onset sepsis with a minimum length of stay of 10 days who underwent a lumbar puncture.
19.5%
Number that met the criteria: / 149
Area covered: Regional
Source: M, Chalia., M, Upton. (2014) Multicentre prospective study in the management of presumed or confirmed early onset sepsis and initiation of treatment in the term and preterm neonatal admissions. Archives of Disease in Childhood No 99 (Suppl 2):A190


Recommendation: 1.6.1.1

Use intravenous benzylpenicillin with gentamicin as the first-choice antibiotic regimen for empirical treatment of suspected infection unless microbiological surveillance data reveal local bacterial resistance patterns indicating a different antibiotic

What was measured: Percent of babies who required intravenous antibiotics for suspected or confirmed early onset sepsis with a minimum length of stay of 10 days who received intravenous benzylpenicillin and gentamicin as first line treatment.
91.3%
Number that met the criteria: / 149
Area covered: Regional
Source: M, Chalia., M, Upton. (2014) Multicentre prospective study in the management of presumed or confirmed early onset sepsis and initiation of treatment in the term and preterm neonatal admissions. Archives of Disease in Childhood No 99 (Suppl 2):A190


Recommendation: 1.7.1.1

In babies given antibiotics because of risk factors for infection or clinical indicators of possible infection, measure the C-reactive protein concentration 18–24 hours after presentation

What was measured: Proportion of neonatal units that repeat C-reactive protein (CRP) in the first 24 hours after initial CRP
Data collection end: October 2014
80%
Number that met the criteria: 45 / 56
Area covered: UK
Source: Mukherjee, A., Ramalingaiah, B., Kennea, N., & Duffy, D. (2015) Management of neonatal early onset sepsis (CG149): compliance of neonatal units in the UK with NICE recommendations. Archives of Disease in Childhood Fetal and Neonatal Edition, 100 (2)


Recommendation: 1.7.1.2

Consider performing a lumbar puncture to obtain a cerebrospinal fluid sample in a baby who did not have a lumbar puncture at presentation who is receiving antibiotics, if it is thought safe to do so and if the baby: has a C-reactive protein concentration of 10 mg/litre or greater, or has a positive blood culture, or does not respond satisfactorily to antibiotic treatment

What was measured: Proportion of neonatal units that would consider lumbar puncture on an asymptomatic baby, if C-reactive protein is >10mg/litre
Data collection end: October 2014
14%
Number that met the criteria: 8 / 56
Area covered: UK
Source: Mukherjee, A., Ramalingaiah, B., Kennea, N., & Duffy, D. (2015) Management of neonatal early onset sepsis (CG149): compliance of neonatal units in the UK with NICE recommendations. Archives of Disease in Childhood Fetal and Neonatal Edition, 100 (2)


Recommendation: 1.7.2.1

"In babies given antibiotics because of risk factors for infection or clinical indicators of possible infection, consider stopping the antibiotics at 36 hours if: the blood culture is negative, and the initial clinical suspicion of infection was not strong, and the baby's clinical condition is reassuring with no clinical indicators of possible infection, and the levels and trends of C-reactive protein concentration are reassuring."

What was measured: The proportion of neonatal units where blood culture results with growth detected or not detected were available at 36 hours.
Data collection end: May 2017
47.5%
Number that met the criteria: 66 / 139
Area covered: UK
Source: Paul S P, Caplan E M, Morgan H A, and Turner P C. (2017). Barriers to implementing the NICE guidelines for early-onset neonatal infection: cross-sectional survey of neonatal blood culture reporting by laboratories in the UK. The Journal of hospital infection, , pp..


Recommendation: 1.7.2.2

Consider establishing hospital systems to provide blood culture results 36 hours after starting antibiotics to facilitate timely discontinuation of treatment and discharge from hospital

What was measured: Proportion of neonatal units with a 36 hour blood culture reporting system
Data collection end: October 2014
45%
Number that met the criteria: 25 / 56
Area covered: UK
Source: Mukherjee, A., Ramalingaiah, B., Kennea, N., & Duffy, D. (2015) Management of neonatal early onset sepsis (CG149): compliance of neonatal units in the UK with NICE recommendations. Archives of Disease in Childhood Fetal and Neonatal Edition, 100 (2)



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